[Preoperative intravenous administration of droperidol (1.25 mg) reduced postoperative nausea and vomiting after intrathecal morphine administration].

BACKGROUND: Intrathecal morphine (ITM) is an excellent postoperative analgesic, but may often cause postoperative nausea and vomiting (PONV). We designed this prospective, randomized and controlled study to evaluate the antiemetic efficacy of low-dose droperidol for the treatment of PONV caused by ITM. METHODS: Two hundred female patients undergoing elective total hip arthroplasty were enrolled. They received spinal anesthesia with isobaric bupivacaine and 0.08 mg ITM, and 100 patients were randomly administered with 1.25 mg droperidol intravenously before operation. We observed the incidence of PONY and pain score until 24 hr after operation, and investigated the doses of anti-hypotensive drugs (ephedrine and phenylephrine) and fluid administered intraoperatively. RESULTS: The incidence of PONV was lower in the droperidol group within 6 hr after operation (control group 47%, droperidol group 15%), and especially lower within 2 hr (43% vs. 3%), but was not different 6 hr after operation. The pain score was very low throughout the observation period in both groups and especially within 12 hr. The respective doses of the anti-hypotensive drugs and fluid administered intraoperatively during the operation were higher in the droperidol group. Severe arrhythmia was not observed in any patient throughout the observation period. CONCLUSIONS: Single intravenous administration of 1.25 mg droperidol before operation showed prophylactic efficacy in early PONV caused by ITM. The duration of droperidol action was shorter than that of ITM. Hence we recommend that droperidol should be administered more frequently or continuously in the postoperative period.

[Conscious sedation and amnesic effect of intravenous low-dose midazolam prior to spinal anesthesia].

BACKGROUND: The pain associated with spinal puncture is severe, and the memory of this uncomfortable procedure often deters patients from undergoing the procedure again. Therefore, it is important to make the patient as comfortable as possible when this procedure is performed. METHODS: We administrated a low-dose (1-2.5 mg) of midazolam intravenously several minutes before conducting a spinal-tap in 200 patients undergoing elective surgery of the lower limb. The dose of midazolam used was based on the patient's age and weight, and we investigated remaining of a memory concerning the spinal-tap procedure and side effects of midazolam at the end of surgery. RESULTS: Memory of the spinal-tap procedure remained in 14.0%, 1.9%, and 32.7% of the patients who had received benzodiazepine preoperatively and in 25.0%, 40.0%, and 60.9% of the patients who hadn't received benzodiazepine preoperatively in the age group <60, 60-70, and > or =70 years, respectively. No patient experienced severe respiratory depression, but an excessive sedation or restlessness was experienced in 1.6%, 4.8%, and 5.2% of the patients. CONCLUSIONS: In the patients aged <70 years, intravenous administration of 0.023-0.044 mg x kg(-1) of midazolam was very effective in preventing a bad memory concerning the spinal-tap procedure; however, it is important to note that the number of side effects associated with this procedure increases in patients aged > or =60 years.